The proposed dissertation study examines the effects of state language policies on the access to health services among immigrants-many of whom are limited English proficient (LEP) and likely to face language barriers. Under federal civil rights law, states are required to ensure that their health systems are accessible to LEP persons. However, due to the lack of oversight and enforcement, a broad "patchwork" of state policies has emerged. In the literature, efforts have been made to describe and catalogue the broad array of state policies as well as to highlight state models, such as California or Washington. However, whether these state policies are effective in improving access to health services among the immigrant population has not been empirically tested and thus, is still not clearly understood. Past studies examining the effectiveness of language service interventions have been largely based in a single setting (such as a hospital or clinic) and do not account for state variation. The specific aims of the study are to: (1) Examine the changes in demographic characteristics for states with differing language policies;(2) Determine whether the disparities in access to health services between the immigrant and US-born populations vary from state to state;(3) Determine whether the disparities in access to health services between the immigrant and US-born populations vary between states with and without specific language policies;and (4) Evaluate the effectiveness of specific state language policies in addressing the disparities in access between immigrants and US-born persons. Three types of state language policies will be assessed, including: funding or reimbursement for language services, efforts to ensure health interpreter competency, and requirements for hospitals or other health care provider organizations. To achieve these aims, this study will draw on a secondary data source, the National Survey of America's Families (NSAF)-a large representative survey of families conducted by the Urban Institute. Unlike other national surveys, the NSAF is designed to provide state-specific estimates and allows for comparisons between a cross-section of thirteen states. To account for the hierarchical nature of the data (i.e. individual nested in states), multi-level modeling will be used to test differences in immigrant access to health services in states with these language policies versus states without such policies. PUBLIC HEALTH RELEVANCE: Relevance and Impact This study evaluates the effectiveness of state language policies in improving access to health services for immigrant populations. States play an important role in the provision of health services, but face tremendous challenges in addressing the healthcare needs of their growing immigrant constituencies-many of whom have problems speaking or understanding the English language. Currently, there is considerable state variation in the policies dealing with language barriers in the health system and little empirical knowledge as to whether these policies work.